Deputy General Manager/General Manger - Claims/Payer Operations - Healthcare/BPM Firm

DGM/GM - Claims/Payer Operations - Healthcare BPM Industry

Mandatory Ask:

- 14-18 years overall experience with min 10+ years in US healthcare claims operations / open to working night shifts.

As A Strategic Thinker:

- Identifying Transformational Value Creation via RPA and Analytics offerings.

- Value additions and Process Improvement Initiatives.

- Account Management.

- Program/ Business Budget and Supply Planning.

- P&L Management (Revenue management, Cost Optimization, Improvements).

- Service Quality Management.

- Client Communications Management.

- Provide strategic direction to assigned lines of businesses.

- Take leadership role in migration to new case management database.

- Stakeholder Management.

- Statutory Audit & Compliance Adherence (HIPAA/ISO/ISMS).

As Driving Results:

- Track program performance and its impact on the financial goal.

- Creating Growth Path/Succession Planning for the process.

- Effective Resource Utilization.

- Define and review KRA of Deputy Manager, Manager, Senior Manager, AGM.

- Identify and participate in training / developmental programs.

- SLA & Metrics Management.

- Responsible for monthly/quarterly/annual performance appraisals of employees in the vertical.

- Support development of program policies, rules, protocols, handbooks, and forms for all program components.

- Identify opportunities to streamline business processes and systems.

- Represent the company and actively participate in operational reviews, MBR s/QBRs.

- Timely reporting of deliverables like Performance Incentive, Internal Dashboards.

- Identifying, recommending, and implementing ways to increase the productivity and the quality of the team.

- Attend to Process Escalation and provide effective solutions.

- Responsible for Balance Score Card and its parameters.

- Attend to Client calls, Stat us Meeting and Client Feedback.

- Review and Regulate SOP.

- Can identify problems and take decisions independently.

- Provides solutions to individual and organizational challenges.

As A Partner With Clients:

- Delivering Highest Level of Service Delivery Standards.

- Exemplify Passion for excellence.

- Design and Drive Business/Program Excellence Initiatives.

- Voice of the Organisation.

Lead People:

- Inspirational Leadership.

- Lead from the front as the SME of the Business/ Program.

- Design & Drive People Metrics.

- Promoting Diversity & Inclusion as per Organizational Culture.

- Mentoring & Coaching Operational & Leadership values.

- Improve employee retention and enhance employee engagement.

- Succession Planning.

Primary Skills:

- Must be working with U.S based Business / Customers in U.S Shifts.

- Statutory Audit & Compliance Adherence (HIPAA/ISO/ISMS).

- Minimum 10+ years of work experience in end-to-end Claims Adjudication domain.

- Business Excellence/ Improvements Projects.

- Managed a large and Complex Delivery Team.

- Minimum Span Management should be 300+ FTE.

- Client & Stakeholder Management.

- P&L Management.

Secondary Skills:

- Preferable Onshore Transition experience.

- Coaching and Mentoring.

- Excellent Communication Skills.

- Excellent Analytical skills.

- Excellent People Management.

- Excellent Presentation Skills.

Qualifications & Mandatory Skills:

- A Bachelor degree or equivalent qualification.

- RPA/ Analytics Certification preferred.

- Preferably Lean/ Six Sigma Certified.

- Ideal candidature would be 14-18 years overall experience with min 7- 10 years in US Healthcare Payer Operations.